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Contract Health Services Coordinator
2 months ago
Position Summary:
This role is essential for initiating, monitoring, and managing health insurance claims as the "payer of last resort" in accordance with the guidelines set forth by the Great Plains Tribal Leaders Health Board Inc. The position demands a comprehensive understanding of Purchased Referred Care services and alternative funding sources, which may encompass private insurance and Medicare/Medicaid programs. Familiarity with the Affordable Care Act (ACA) and effective funds management techniques to oversee the allocated budget for Purchased/Referred Care services is also crucial. Additionally, a solid grasp of specialized medical terminology, including diagnostic and procedural language, is required.
Key Responsibilities:
- Maintain accurate records for Contract Health Services.
- Assess incoming referrals to ensure they align with the approved priorities.
- Prepare and follow up on referrals requiring medical and dental evaluations.
- Evaluate client eligibility and refer to alternative resources for screening when applicable.
- Coordinate with external providers to arrange appointments for approved cases, obtain cost estimates, and inform clients of scheduled visits. Generate purchase orders for eligible referrals.
- Engage in communication with external agencies and clients regarding claim submissions.
- Provide updates to clients and providers about the status of Contract Health Services claims.
- Collaborate with internal providers to clarify referrals and address case inquiries.
- Track cases through the appointment process, procedural scheduling, outcome assessments, insurance eligibility determinations, and final claims processing.
- Manage and submit reimbursement claims through Contract Health Services.
- Prepare and submit cases for the Catastrophic Health Emergency Fund (CHEF) in accordance with IHS guidelines, and notify supervisors of potential CHEF cases for committee reporting.
- Respond to inquiries and requests for assistance with PRC services via various communication methods, coordinating responses and providing consultation to resolve issues.
- Adhere to federal laws and regulations as mandated by the Health Insurance Portability and Accountability Act (HIPAA).
- Perform additional related duties as required.
Professional Conduct:
- Plan and organize workload effectively to meet job demands.
- Collaborate professionally with colleagues and stakeholders.
- Show respect and dignity towards Great Plains tribes and partners.
- Utilize strong verbal and written communication skills.
- Engage in ongoing personal educational development through training and seminars.
- Provide exceptional customer service to all stakeholders.
- Foster a workplace culture of wellness, courtesy, and respect.
- Work collaboratively with all staff levels in a professional manner.
- Demonstrate respect for diverse backgrounds and capabilities.
- Ensure organizational privacy and confidentiality is maintained.
- Manage stress and crises with professionalism.
- Take initiative to assist others proactively.
- Resolve interdepartmental issues independently when necessary.
- Adapt to changing situations while maintaining a positive work environment.
- Promote a lifestyle free from alcohol, tobacco, and drugs.
- Maintain a professional appearance and demeanor.
- Comply with organizational policies and procedures.
Qualifications:
- Demonstrated commitment to excellent customer service.
- Experience working with American Indian populations and an understanding of their cultural practices.
- Ability to respect and accept diverse backgrounds and perspectives.
- Capacity to handle crises and manage stress effectively.
- Self-motivated with a proactive approach to problem-solving.
- Flexibility to adjust plans as needed while maintaining performance.
- Willingness to maintain a flexible work schedule, including potential travel.
- Effective presentation skills in various settings.
- Proficiency in computer applications such as Word, Excel, and PowerPoint.
- Valid driver's license and compliance with relevant regulations.
- Commitment to promoting a drug-free lifestyle.
- Professional appearance and adherence to organizational standards.
Supervisory Structure:
The supervisor provides general instructions and reviews work for compliance with established procedures and outcomes through meetings and reports.
Guidelines:
Guidelines include state and federal laws, organizational policies, and IHS protocols, requiring sound judgment and interpretation.
Work Complexity:
This position encompasses diverse administrative and technical responsibilities aimed at supporting the PRC Program's operations.
Contact Scope:
Interactions typically involve patients, organizational staff, public members, and other healthcare providers to exchange essential medical information.
Work Environment:
The role is primarily office-based, requiring periods of sitting, standing, and light lifting. The work environment is generally quiet, with occasional exposure to outdoor conditions.
Supervisory Responsibilities:
This position does not have supervisory duties.
Education and Experience:
- High school diploma or equivalent.
- Three years of administrative support experience, including one year in purchased referred care, is preferred.
- Successful completion of a criminal background check and drug screening is required.
Tribal Preference:
The Great Plains Tribal Leaders Health Board Inc. follows tribal preference laws in hiring, prioritizing qualified Indian/Tribal candidates when qualifications are equal.
Application Process:
To apply, complete the online employment application available on the organization's website.
Employment Acknowledgment:
This job description is not a contract of employment. Employees are responsible for understanding and complying with the duties outlined herein.
